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Friday, July 29, 2011



I was so happy to see that the Alzheimer's Association International Conference in Paris this year presented a symposium which highlighted the increasing evidence of functional and cognitive benefits seen when patients with Alzheimer's are taking a combination of one of the cholinesterase inhibitors (Aricept, Exelon or Razadyne), plus Namenda. The experts concluded that this combination is the best option we have today to help preserve cognitive and functional abilities, and studies are on-going to see at just what stage this combination intervention is most beneficial and for how long. So, if your loved one is on one of these medications, ask the physician to add the other for an increased benefit. These two types of drugs work in completely different ways in the brain, and they are both more effective together than either one is when used alone.
Also, something I recently learned is that a person can build up somewhat of a tolerance to the cholinesterase inhibitors over a period of years, so it may be beneficial to bump up the dose if they're not already at the maximum dose.

Friday, July 15, 2011



Far too often, those family docs who many elders have been seeing for years just can't keep up with advances in medicine. This can mean that your parent or spouse does not get a "dementia work-up" when signs and symptoms are clearly present, nor does that elder get the medication that could help slow down the progression of their dementia. The American Geriatrics Society has recently made available their newest tool to help clinicians not only diagnose, but treat dementia and the psychosis and behavioral problems that can accompany it. It is titled Guide to the Management of Psychotic Disorder and Neuropsychiatric Symptoms of Dementia in Older Adults, and can be viewed on their website at www.americangeriatrics.org. A smartphone version of this valuable tool, called GeriPsych Consult will be available soon.
Dementia is not the only subject covered in this Guide. Bipolar disorder, depression, and schizophrenia are all included along with the behavioral symptoms that are often associated with different types of dementia, including Alzheimer's.
I especially like the way the AGS has put much of this information into Tables for easy comparison. For example, seven antipsychotics are listed in a Table which shows side effects (and they ALL have multiple side effects) that makes it easy to see which drugs should not be given to a diabetic, or someone with a seizure disorder.
I was especially happy to see the AGS has suggested under "Agitation or Aggression" to "Always consider nonpharmacologic strategies first..." and they go on to list a number of things that will always made the person with dementia escalate in their agitation. The AGS also makes note of the Black Box warnings on these drugs and how they are being used "off label" in people with dementia, and they go so far as to include a "summary of studies regarding excess mortality associated with antipsychotic medication use in patients with dementia."
This is critical information for all healthcare providers to have access to, and now it's at your fingertips also! Thanks AGS!

Friday, July 08, 2011



We've often heard the term "sundowning" used to describe the animated behaviors of some people with dementia, usually at the end of the afternoon and early evening hours. This can involve agitation, restlessness, combativeness, refusals to sit down and eat and a host of other behaviors. There are no widely accepted answers as to why this occurs in some people with dementia and several theories have been proposed. Some believe that when the sun goes down it triggers these behaviors in some people, or that it's a disruption of the sleep-wake cycle clock in the brain. Others think it is linked to fatigue, but it presents significant problems for the caregivers of those elders.
I have not seen any studies come out about this disorder until recently in Medical News Today (http://www.medicalnewstoday.com/releases/229757.php) where Tracy Bedrosian at Ohio State University conducted studies with mice that showed sundowning-type behaviors had a biological basis. They found higher levels of an enzyme called acetylcholinesterase, as well as differences in two other proteins in the brains of the aged mice exhibiting the symptoms of sundowning. This is good news because it means there is a good chance it can be successfully treated if the cause is biologically based. While it would be years before the leap from mice to men could occur with any treatment, to me it's very hopeful that they're even working on this problem and that they may have found a starting point for treatment in the mice.

Friday, July 01, 2011



Researchers in the Department of Zoology at Tel Aviv University recently published their findings on how an extract found in cinnamon bark (CEppt) can inhibit development of Alzheimer's. Professors Ovadia, Gazit, Segal and Frenkel published this article in the journal PLoS ONE, and I found this information through Medical News Today (URL:http://www.medicalnewstoday.com/releases/229809.php).
The researchers conducted their studies on mice who were genetically altered to develop Alzheimer's, as well as fruit flies. After giving the extract in water for four months, they found decreased levels of development of Alzheimer's and activity levels and longevity were then comparable to healthy animals and flies. They stated the extract breaks up amyloid fibers, as well as inhibited the formation of the oligomers and fibrils that lead to plaque in the brain of Alzheimer's victims.
As always, it's a HUGE leap from mice and fruit flies to man, plus you would need to take a toxic level of cinnamon in order to receive the therapeutic benefits seen in the studies. BUT--it's exciting to know that this simple spice, which is already known to have benefits for taming blood sugars, and preventing viral infections, is now being studied as a possible prevention or cure for Alzheimer's--most likely without side effects! Time will tell as the researchers continue their quest and we'll keep hoping.


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Cindy Keith, RN, BS,
Certified Dementia Practitioner

Nationally Known Speaker
On Dementia and Alzheimer's Care

Phone 814-235-0691

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